Efficacy of Combined Septal Extension and Derotation Grafts in Asian Rhinoplasty: A Quantitative Analysis of Tip Projection and Stability

Background Short nose correction in Asian rhinoplasty is challenging due to weak septal cartilage, thick skin envelopes, and strong postoperative contractile forces that compromise long-term tip stability. Objectives This study aimed to quantitatively compare the long-term outcomes of three nasal tip–plasty techniques—derotation graft with columellar strut (DG+CS), septal extension graft alone (SEG only), and combined septal extension with derotation graft (SEG+DG). Methods A total of 324 patients who underwent cosmetic rhinoplasty by a single surgeon from 2015 to 2022 were retrospectively analyzed. Standardized lateral-view photographs were used to measure nasal length, tip projection, and nasolabial angle, normalized to facial length, and expressed as percentage change over time. Long-term outcomes (>12 months) were compared using non-parametric statistical tests. Results The SEG+DG group demonstrated the most consistent and durable improvements in nasal length and tip projection across all postoperative intervals. Significant intergroup differences were observed in long-term nasal length and tip projection (p < 0.001), with SEG+DG and SEG only both outperforming DG+CS. SEG+DG also showed the lowest variability and most stable trend, whereas the nasolabial angle showed a significant omnibus difference (p = 0.009) that did not persist after post-hoc pairwise correction. Revision rates were lowest in the SEG+DG group (6.5%), compared to SEG only (10.6%) and DG+CS (14.3%). Conclusions The combined use of septal extension and derotation grafts provides superior and sustained structural support, offering a more reliable approach for correcting short nose deformity in Asian rhinoplasty.